I was reading Bill Gardner’s article on The Incidental Economist, Prediction: SCOTUS will find for the King plaintiffs, and I was perplexed by this statement.
The constitutional outcome of a victory for the King plaintiffs would be a radically decentralized federalism.
Since we already have existing state exchanges I am not sure how “radical” of a change this would be. Then I stumbled over the words “decentralized federalism”. Wikipedia defines federalism as,
The term “federalism” is also used to describe a system of government in which sovereignty is constitutionally divided between a central governing authority and constituent political units (such as states or provinces)
I suspect Bill is complaining over the perceived change from a centralized form of federalism to a more decentralized form. Since the states and and the federal government are already using a form of this decentralized federalism in running Medicaid, I do not see a problem if the Affordable Care Act respects the constitutional limits assigned to it. Since no one has attempted to make the case that the federal government has an overriding constitutional issue that requires them to regulate state health insurance, I find it fascinating that Bill was naïve enough to think anything other than decentralized federalism would be constitutionally acceptable. Congress knew that the Affordable Care Act was stuck with state exchanges with some type of federal support and no amount of wishful thinking was going to change that. The federal exchange would be created as a convenience to those states that could not afford to create and manage their own exchange. It was to be the exception and not the rule. The requirement of state exchanges is not a new argument. It was one of the points being made by Senator Baucus in this CNN clip, “Senate Hearing: Tax Credits are available for State Exchanges Only. Senator Baucus explains how The Affordable Care Act sets conditions where Tax Credits are available for State Exchanges Only.“
Since I would like to see major changes in the Affordable Care Act in 2015 rather than 2017, I hope SCOTUS rules in favor of the plaintiffs. The King is dead, long live The King!